Intensive Care Unit Equipment (Encyclopedia of Nursing & Allied Health)

Definition

Intensive care unit (ICU) equipment includes patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation devices, and other life support equipment designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure, thereby requiring 24-hour care and monitoring.

Purpose

An ICU may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions. For example, a neuromedical ICU would care for patients with acute conditions involving the nervous system or for patients who have just had neurosurgical procedures and would require equipment for monitoring and assessing the brain and spinal cord. A neonatal ICU is designed and equipped to care for infants who are ill, born prematurely, or have a condition requiring constant monitoring.

Patient monitoring equipment

Patient monitoring equipment includes the following:

• Acute care physiologic monitoring systemContinuously measures and displays data on vital signs, such as heart rate, blood pressure, cardiac output, and blood oxygen levels.
• Pulse oximeteronitors the oxygen saturation in the blood.
• Intracranial pressure monitoreasures the pressure of fluid in the brain in patients with head trauma or other conditions affecting the brain (such as tumors, edema, or hemorraging).
• Apnea monitorontinuously monitors breathing to detect cessation in infants and adults at risk of respiratory failure.

Life support and emergency resuscitative equipment

ICU equipment for life support and emergency resuscitation include the following:

• Ventilator (also called a respirator)ssists with or controls pulmonary ventilation in patients who cannot breathe on their own.
• Infusion pumpevice that delivers fluids intravenously or epidurally, including continuous anesthesia, drugs, and blood infusions.
• Crash cartortable cart containing emergency resuscitation equipment for patients who are "coding" (that is, their vital signs are in a dangerous range), including a defibrillator, airway intubation devices, resuscitation bag/mask, and medication box.
• Intra-aortic balloon pump device that helps reduce the heart's workload and helps blood flow to the coronary arteries for patients with unstable angina, myocardial infarction, or patients awaiting transplants.

The use of diagnostic equipment is also required in the ICU. Mobile x-ray units are used for bedside radiography, particularly of the chest. Portable clinical laboratory devices, called point-of-care analyzers, are used for blood analysis at the bedside to provide results much faster than if samples were sent to the central laboratory.

Disposable ICU equipment includes urinary (Foley) catheters, catheters used for arterial and central venous lines, Swan-Ganz catheters, chest and endotracheal tubes, gastrointestinal and nasogastric feeding tubes, and monitoring electrodes.

Description

ICU equipment includes patient monitoring, life support and emergency resuscitation devices, and diagnostic devices.

Patient monitoring equipment

• Acute care physiologic monitoring systems are comprehensive patient monitoring systems that can be configured to measure and display various parameters, such as an electrocardiogram (ECG), respiratory rate, blood pressure (noninvasive and invasive), body temperature, cardiac output, arterial hemoglobin oxygen saturation, mixed venous oxygenation, and end-tidal carbon dioxide, via electrodes and sensors connected to the patient. Each patient bed in an ICU has a physiologic monitor, and all monitors are networked to a central nurses'
• Pulse oximeters measure the arterial hemoglobin oxygen saturation of the patient's blood with a sensor clipped over the finger or toe. Pulse oximetry is usually a capability included in a physiologic monitoring system, but the ICU also uses dedicated pulse oximeters for some patients.
• Intracranial pressure monitors are connected to sensors inserted into the brain through a cannula or bur hole. These devices warn of elevated pressure and record or display pressure trends. Intracranial pressure monitoring may be a capability included in a physiologic monitor.
• Apnea monitors use electrodes or sensors placed on the patient to detect cessation of breathing, display respiration parameters, and trigger an alarm if a certain amount of time passes without a patient's breath being detected. Apnea monitoring may be a capability included in a physiologic monitor.

Life support and emergency resuscitative equipment

• Ventilators consist of a flexible breathing circuit, gas supply, heating/humidification mechanism, monitors, and alarms. They are microprocessor-controlled and programmable, and regulate the volume, pressure, and flow of patient respiration. Ventilator monitors and alarms may be interfaced to a central monitoring system or information system.
• Infusion pumps employ automatic, programmable pumping mechanisms to supply the patient with fluids intravenously or epidurally through a catheter. The pump is hung on an intravenous pole, which is located next to the patient's bed.
• Crash carts, also called resuscitation carts or code carts, are strategically located in the ICU for immediate availability when a patient experiences cardiorespiratory failure. The cart holds a defibrillator, which is used to apply an electric shock to a patient in ventricular fibrillation. Two paddles are placed on the patient's chest and buttons are pressed to discharge an electrical shock of approximately 2,000 to 4,000 volts. The cart also holds a resuscitator, which is inserted into the patient's airway, and a bag is pressed to push air into the lungs.
• Intra-aortic balloon pumps use a balloon placed in the patient's aorta to help the heart pump. The balloon is on the end of a catheter that is connected to the pump's console, which displays heart rate, pressure, and ECG readings. The patient's ECG is used to time the inflation and deflation of the balloon.

Diagnostic devices most commonly used in the ICU are mobile x-ray units, which can be pushed to the patient's bedside to take x rays using a battery-operated generator that powers an x-ray tube, and point-of-care blood analyzers, which are handheld devices that require a small amount of whole blood and display blood chemistry parameters.

Operation

The ICU is a demanding environment due to the critical condition of patients and the variety of equipment necessary to support and monitor patients. Therefore, when operating ICU equipment, staff should pay attention to the types of devices and the variations between different models of the same type of device, so as not to make an error in operation or adjustment. Although many

KEY TERMS

Apneaessation of breathing.

Arterial line catheter inserted into an artery and connected to a physiologic monitoring system to allow direct measurement of oxygen, carbon dioxide, and invasive blood pressure.

Edeman abnormal accumulation of fluids in intercellular spaces in the body; causes swelling.

Central venous line catheter inserted into a vein and connected to a physiologic monitoring system to directly measure venous blood pressure.

Chest tube tube inserted into the chest to drain fluid and air from around the lungs.

Endotracheal tube tube inserted through the patient's nose or mouth that functions as an airway and is connected to the ventilator.

Gastrointestinal tube tube surgically inserted into the stomach for feeding a patient unable to eat by mouth.

Nasogastric tube tube inserted through the nose and throat and into the stomach for direct feeding of the patient.

Ventricular fibrillationn irregular cardiac rhythm characterized by contractions of the ventricular muscle of the heart and signaling impending cardiac arrest; treated by using a defibrillator and medications.

hospitals make an effort to standardize equipment, for example, using the same manufacturer's infusion pumps or patient monitoring systems, older devices and nonstandardized equipment may still be used, particularly when the ICU is busy. Clinical staff should be sure to check all devices and settings to ensure patient safety.

ICU patient monitoring systems are equipped with alarms that sound when the patient's vital signs deteriorate, for instance, when breathing stops, blood pressure is too high or too low, or when heart rate is too fast or too slow. Usually, all patient monitors connect to a central nurses' station for easy supervision. ICU staff should be sure that all alarms are functioning properly and that the central station is staffed at all times.

For reusable patient care equipment, clinical staff should be sure to properly disinfect and sterilize devices that contact patients. Disposable items, such as catheters and needles, should be disposed of in an appropriately labeled container.

Maintenance

Since ICU equipment is used continuously on critically ill patients, it is essential that equipment be properly maintained, particularly those devices used for life support and resuscitation. ICU staff should perform daily checks on equipment and inform biomedical engineering staff when equipment needs maintenance, repair, or replacement. For mechanically complex devices, service and preventive maintenance contracts are available from the manufacturer or third-party servicing companies.

Health care team roles

ICU equipment is used by an ICU care team, which consists of a critical care attending physician, ICU nurses, respiratory therapists, pharmacists, physical therapists, and nutritionists. Physicians trained in other specialties, such as anesthesiology, cardiology, radiology, surgery, neurology, pediatrics, and orthopedics, may be consulted and called to the ICU to treat patients who require their expertise. Radiologic technologists perform mobile x-ray examinations (bedside radiography). Either nurses or clinical laboratory personnel perform point-of-care blood analysis. ICU equipment is maintained and repaired by the hospital biomedical engineering staff and/or the equipment manufacturer.

Some studies have shown that patients in the ICU following high-risk surgery are at least three times as likely to survive when cared for by "intensivists," physicians trained in critical care medicine.

Training

Manufacturers of more sophisticated ICU equipment, such as ventilators and patient monitoring devices, provide clinical training for all involved staff when the device is purchased. All ICU staff must have undergone specialized training in the care of critically ill patients and must be trained to respond to life-threatening situations, since ICU patients are in critical condition and may experience respiratory or cardiac emergencies.

Jennifer E. Sisk, M.A.